[18F] With chronic daily headaches and associated symptoms

Patient Description

An 18-year-old female reports experiencing daily headaches that last all day and only subside when she goes to bed. The headaches start with mild pain but progressively intensify to a severe level, described as a 10 on a pain scale. The pain is characterized by a throbbing sensation, predominantly in the middle of the forehead and sometimes in the temples. The patient is sensitive to light, sound, and movement during these episodes, finding relief by lying down in a dark room without moving. The headaches have been present since childhood, and she was diagnosed with migraines at a young age. She also experiences a sensation of dragging herself when moving and reports generalized body weakness, particularly in the legs, during these headaches. There are no associated symptoms of nausea, vomiting, visual disturbances, or speech difficulties. Identified triggers include lack of sleep and stress, with the patient typically getting around 6 hours of sleep per night due to insomnia, stress, and a tendency to procrastinate about sleep. She has previously used Zavzpret nasal spray with good effect but is unsure how to obtain it again. Her medical history includes arthritis and psoriasis, diagnosed in infancy. She is allergic to penicillin and is not currently taking any medications. The patient also mentioned the use of unspecified substances.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Chronic Migraines: Given your history of migraines and the nature of your headaches (daily occurrence, throbbing pain, sensitivity to light and sound, and relief in a dark room), chronic migraines are a likely diagnosis. Chronic migraines are defined as headaches occurring on 15 or more days per month for more than three months, with at least eight days per month having migraine features.

    • Treatment: Treatment typically involves both acute and preventive medications. Acute treatments include triptans, NSAIDs, and anti-nausea medications. Preventive treatments may include beta-blockers, antidepressants, anticonvulsants, and CGRP inhibitors like the Zavzpret nasal spray you mentioned. Lifestyle changes, such as improving sleep hygiene and stress management, are also important.
  • Tension-Type Headaches: These are characterized by a constant, dull, aching pain, often described as a tight band around the head. They can be triggered by stress, lack of sleep, and poor posture.

    • Treatment: Over-the-counter pain relievers like ibuprofen or acetaminophen can help. Stress management techniques, regular exercise, and proper sleep hygiene are also beneficial.
  • Sleep Disorders: Your insomnia and lack of sleep could be contributing significantly to your headaches. Poor sleep quality and quantity are common triggers for both migraines and tension-type headaches.

    • Treatment: Addressing the underlying sleep disorder is crucial. This may involve cognitive-behavioral therapy for insomnia (CBT-I), improving sleep hygiene, and possibly medications prescribed by a healthcare provider.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take to manage your symptoms:

  1. Maintain a Headache Diary: Use MDandMe to journal your symptoms, track your headaches, and identify potential triggers. This information can be very helpful for your healthcare provider.
  2. Improve Sleep Hygiene: Establish a regular sleep schedule, create a relaxing bedtime routine, and make your sleep environment comfortable and free of distractions. Avoid caffeine and electronic devices before bed.
  3. Manage Stress: Practice stress-reducing techniques such as deep breathing exercises, meditation, or yoga. Regular physical activity can also help reduce stress.
  4. Stay Hydrated and Eat Regularly: Dehydration and skipping meals can trigger headaches. Make sure to drink plenty of water and eat balanced meals at regular intervals.
  5. Limit Exposure to Triggers: Since you are sensitive to light and sound, try to limit your exposure to bright lights and loud noises. Use sunglasses or earplugs if necessary.
  6. Consult a Healthcare Provider: Discuss your symptoms and treatment options with a healthcare provider. They can prescribe medications like Zavzpret nasal spray and recommend other treatments tailored to your needs.

What you should look out for

Seek medical attention if you experience any of the following:

  • Sudden, Severe Headache: A headache that comes on suddenly and is extremely severe could be a sign of a more serious condition.
  • Neurological Symptoms: If you experience weakness, numbness, difficulty speaking, or vision changes that are new or worsening, seek immediate medical attention.
  • Changes in Headache Pattern: If your headaches change in frequency, intensity, or nature, it's important to consult a healthcare provider.
  • Inability to Manage Symptoms: If your current management strategies are not effective and your headaches are significantly impacting your quality of life, seek professional help.

Remember, while I can provide information and suggestions, it's essential to consult with a healthcare professional for a formal diagnosis and personalized treatment plan.

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5 mo ago

People Also Ask


What are the common triggers for migraines and how can they be managed?

Common triggers for migraines include stress, lack of sleep, certain foods, dehydration, and hormonal changes. Managing these triggers involves maintaining a regular sleep schedule, staying hydrated, managing stress through relaxation techniques, and avoiding known dietary triggers.


How can sleep disorders contribute to headaches, and what are some strategies to improve sleep?

Sleep disorders can lead to headaches by disrupting the body's natural rest and recovery processes. Strategies to improve sleep include establishing a regular sleep routine, creating a comfortable sleep environment, avoiding caffeine and electronics before bed, and considering cognitive-behavioral therapy for insomnia.


What are the differences between chronic migraines and tension-type headaches?

Chronic migraines are characterized by headaches occurring on 15 or more days per month with migraine features, such as throbbing pain and sensitivity to light and sound. Tension-type headaches are usually described as a constant, dull, aching pain, often like a tight band around the head, and are typically triggered by stress and poor posture.


What are some effective treatments for managing chronic migraines?

Effective treatments for chronic migraines include both acute and preventive medications. Acute treatments may involve triptans and NSAIDs, while preventive treatments can include beta-blockers, antidepressants, anticonvulsants, and CGRP inhibitors. Lifestyle changes, such as improving sleep hygiene and stress management, are also important.


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